Improving the Ecological Validity of Cognitive Assessments : Virtual Reality Testing of Prospective Memory Following Chemotherapy Treatments for Breast Cancer
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Improving the Ecological Validity of Cognitive Assessments: Virtual Reality Testing of Prospective Memory Following Chemotherapy Treatments for Breast Cancer M Mary E. E Mih Mihuta t 1, Heather H th JJ. G Green1, David D id W W. K K. M Man2, & D David id H H. K K. Shum1 1School S h l off A Applied li d P Psychology h l &B Behavioural h i lB Basis i off H Health lth R Research h Program, Griffith Health Institute, Griffith University, Gold Coast, Australia 2Department of Rehabilitation Sciences, Sciences The Hong Kong Polytechnic University, Hung Hom, Hong Kong, People's Republic of China ICCTF International Cognition & Cancer Taskforce Conference Paris, France 15-17 March 2012 Conflicting Perspectives/Emphases Researchers Patients “Mild”, “subtle” Objective Absolute deficits ICCTF International Cognition and Cancer Task Force Conference Functional outcome Subjective Relative deficits March 15 15--17 th 2012 – PARIS - FRANCE Ecological Validity “Functional and predictive relationship between the patient’s performance on a p y g tests and the set of neuropsychological patient’s behavior in a variety of real world settings” (Sbordone, settings (Sbordone 1996) 2 approaches (Spooner & Pachana, 2006) Verisimilitude: Match between test task demands and everyday environment demands Veridicality: Statistical r’ship to scores on other measures related to everyday y y performance p ICCTF International Cognition and Cancer Task Force Conference March 15 15--17 th 2012 – PARIS - FRANCE Present Study Ecological validity 1. Prospective memory (PM) 2. Virtual reality testing (VR) Research comparability: ICCTFrecommended d d measures 1. Trailmaking Test, Hopkins Verbal Learning Task, Controlled Oral Word Fluency Test g3 2. FACT-Cog ICCTF International Cognition and Cancer Task Force Conference March 15 15--17 th 2012 – PARIS - FRANCE Prospective Memory “Realization of delayed intentions” (Ellis, 1996) C Components t (Glisky, 1996): Forming and organizing an intention Remembering R b i th the iintention t ti over a d delay l Monitoring the execution of the intention Performing the intention Remembering it has been performed. Types 1. Event-based 2. Time-based 3. Activity-based ICCTF International Cognition and Cancer Task Force Conference March 15 15--17 th 2012 – PARIS - FRANCE Virtual Reality Human-computer interaction where users are active participants within a computergenerated virtual world ((Riva,, 2002)) g High level of control of the interaction Enriched experience for the patient ICCTF International Cognition and Cancer Task Force Conference March 15 15--17 th 2012 – PARIS - FRANCE Participant Groups 1. 26 women who had completed chemotherapy treatment for breast cancer p p g 6-60 months before participating 2. 25 women who had never had cancer, matched for age & education ICCTF International Cognition and Cancer Task Force Conference March 15 15--17 th 2012 – PARIS - FRANCE Inside of VR Shopping Centre ICCTF International Cognition and Cancer Task Force Conference March 15 15--17 th 2012 – PARIS - FRANCE Floor Plan (arrow shows current location) ICCTF International Cognition and Cancer Task Force Conference March 15 15--17 th 2012 – PARIS - FRANCE Prompt when directly aligned outside shop ICCTF International Cognition and Cancer Task Force Conference March 15 15--17 th 2012 – PARIS - FRANCE Prompt when directly aligned outside shop ICCTF International Cognition and Cancer Task Force Conference March 15 15--17 th 2012 – PARIS - FRANCE Measures PM Event-based (VR sale announcements) Time-based Time based (VR SMS messages) Activity-based (Questionnaire prompting, questionnaire return) Event-based (Quiz – animal words) Paper-and-pencil neuropsychological tests TMT, HVLT HVLT-R, R, COWAT Self-report FACT C 3 CAPM FACT-Cog3, CAPM-Brief, B i f K10 Di Distress t ICCTF International Cognition and Cancer Task Force Conference March 15 15--17 th 2012 – PARIS - FRANCE Participant Characteristics Variable BC Comparison p Age 53 0 (6 53.0 (6.6) 6) 50 4 (6 50.4 (6.5) 5) .163 163 Years of Education 14.2 (3.7) 15.1 (4.2) .416 K10 Distress 16.8 (5.1) 16.4 (4.0) .798 Live with partner 65% 72% .611 English first language 100% 88% .110 ICCTF International Cognition and Cancer Task Force Conference March 15 15--17 th 2012 – PARIS - FRANCE Self-Reported Everyday Cognition Variable BC Comparison p FACT Perceived Cog Impairments 49 4 (18 49.4 (18.0) 0) 64 3 (10 64.3 (10.6) 6) .001 001 FACT Comments from Others 14.8 ( 1.4) 15.6 ( 0.7) .017 FACT Perceived Cognitive Abilities 20.2 ( 7.7) 28.9 ( 5.2) .000 FACT Impaired Quality of Life 11.5 ( 4.7) 14.4 ( 2.8) .000 CAPM Instrumental Activities 2.1 ( 0.6) 1.6 ( 0.4) .002 CAPM Basic Activities 1.3 ( 0.4) 1.2 ( 0.2) .159 •FACT-PCI e.g., “I have had trouble finding my way to a familiar place” •FACT-CFO e.g., “Other people have told me I seemed confused” •FACT-PCA e.g., “I am able to keep track of what I am doing, even if I am interrupted” p •FACT-IQL e.g., “These problems have interfered with my ability to do things I enjoy” CAPM-Instrumental e.g., e g “Forgetting Forgetting to buy an item at the grocery store” store •CAPM-Instrumental •CAPM-Basic e.g., “Forgetting to have a shower or bath “ ICCTF International Cognition and Cancer Task Force Conference March 15 15--17 th 2012 – PARIS - FRANCE Cognitive Performance Variable (potential range) BC Comparison p Event-based PM (quiz; 0-6) 4 2 (2 4.2 (2.1) 1) 4 7 (2 4.7 (2.0) 0) .407 407 Event-based PM (VR; 0-3) 2.96 (0.2) 2.96 (0.2) .999 Time-based PM (VR; 0-3) 1.7 ( 1.2) 1.8 ( 1.1) .808 Activity-based PM 1 (0-2) 1.2 ( 0.5) 1.2 ( 0.4) .764 Activity-based PM 2 (0-2) 1.2 ( 1.0) 1.5 ( 0.8) .350 Trails A 26.5 ( 6.7) 21.3 ( 3.6) .001 Trails B 56.9 (17.6) 48.1 (11.2) .039 Controlled Oral Word Assoc 45 5 ( 8 45.5 8.7) 7) 49 9 (12 49.9 (12.8) 8) .162 162 HVLT-R Trials 1-3 25.3 ( 5.3) 25.8 ( 4.1) .742 HVLT-R Retention 98.3 ((16.2)) 93.7 ( 9.2)) .224 ICCTF International Cognition and Cancer Task Force Conference March 15 15--17 th 2012 – PARIS - FRANCE Ongoing Tasks Variable (potential range) BC Comparison p Quiz questions answered (0-80) 59 9 (8 59.9 (8.2) 2) 64 8 (9 64.8 (9.5) 5) .054 054 Quiz questions % correct (0-100) 87.9 (4.0) 89.3 (5.1) .263 VR shopping list items completed (0-12) 9.2 (2.5) 10.5 (2.1) .051 Quiz question e.g., What does the koala’s diet mainly consist of? a) Eucalyptus leaves b) Various small berries c) Tree bark Shopping list item e.g., “Buy a textbook at the book shop” ICCTF International Cognition and Cancer Task Force Conference March 15 15--17 th 2012 – PARIS - FRANCE Summary Compared to age, gender, and education matched t h d participants, ti i t women who h h had db been treated with chemotherapy for breast cancer showed h d Significantly slower speed of processing on T il ki Task Trailmaking T k and d a ttrend d to t fewer f items it completed in computer tasks Impaired self self-reported reported cognitive performance on FACT-Cog and prospective memory (instrumental activities) No difference to comparison group on other prospective p p memory y or neuropsychological p y g measures ICCTF International Cognition and Cancer Task Force Conference March 15 15--17 th 2012 – PARIS - FRANCE Conclusions Prospective memory could be investigated further in relation to cancer-related g function cognitive Calibrating task difficulty is needed P i attention Paying tt ti tto ecological l i l validity lidit off measures has the potential to help bridge the gap between self-report and laboratory tasks ICCTF International Cognition and Cancer Task Force Conference March 15 15--17 th 2012 – PARIS - FRANCE
